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The Alabama Central Registry Clearance form is an essential document used by individuals and organizations involved in the care of children. This form is required to assess whether a person has a history of child abuse or neglect, ensuring the safety and well-being of children under their supervision. The form must be completed accurately, with clear instructions provided for submission. It includes sections for the requesting person or agency, detailing their role and contact information. Individuals seeking clearance must provide personal details, including their name, date of birth, and any aliases. Furthermore, the form requires information about the individual's family, such as spouses and children, as well as their previous addresses in Alabama. The person being cleared must authorize the Alabama Department of Human Resources to release relevant information from the Central Registry, waiving their right to review or appeal. After submission, the Department will conduct a search of the registry and provide the results, which may include substantiated reports of abuse or neglect. This process is crucial for maintaining safe environments for children in various care settings, from daycares to residential facilities.

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ALABAMA DEPARTMENT OF HUMAN RESOURCES

CHILD ABUSE / NEGLECT (CA/N) CENTRAL REGISTRY CLEARANCE

PRINT OR TYPE in black or blue ink. Additional information regarding the CA/N Central Registry is on the back of this form.

** See instructions for the address to use when submitting this form. **

Requesting Person or Agency/Organization

 

 

Check All That Apply

 

 

 

 

 

 

Mailing Address

 

 

 

 

Child Placing Agency

 

 

 

 

 

 

 

 

 

 

 

Residential Child Care Facility

 

 

 

 

 

 

 

 

 

 

 

Child Day / Night Care Center

 

 

 

 

 

 

Telephone Number (

)

 

Email:

 

Family Day / Night Care Home

 

 

 

 

 

 

PRINT Requestor’s Name

 

 

 

 

Exempt Child Day Care Center

 

 

 

 

 

 

Requestor

 

 

 

Date

Medicaid Rehab. Provider

Signature

 

 

 

 

DHR Vendor

 

 

 

 

 

 

Witness

 

 

 

Date

Other (Please Specify)

Signature

 

 

 

 

_________________________________

 

 

 

 

 

The person whose name and identifying information, printed or typed below, will provide unsupervised care and

supervision of children as an

employee

volunteer

other. This person’s specific job/role is or will be:

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Name _____________________________________________ Sex

Last First Middle

Male

Race ___________ DOB ___/___/______

Female

 

Current Mailing Address

__________________________________________________________________________

Alias, Maiden & Prior Married Name(s)

______________________________________________________________

Name & DOB of Spouse & Former Spouse(s)

_________________________________________________________

Name & DOB of Children / Stepchildren

______________________________________________________________

Alabama counties where person has lived and/or worked

_________________________________________________

Attach additional pages as needed to provide all information requested above.

To be completed by person being cleared

I authorize the Alabama Department of Human Resources to release information contained in the Child Abuse / Neglect Central Registry about me to the above named person/agency/organization. I hereby waive any right to any review or hearing to which I may otherwise be entitled. I further release the Department of Human Resources, its officers, and employees from any and all claims arising out of or in any way connected to the release or dissemination of any information concerning me.

_________________________________

________________

_________________________________

________________

Signature

Date

Signature of Witness

Date

To be completed by DHR

A search of the Alabama Child Abuse / Neglect Central Registry has been completed with the information provided to determine if the person identified above has been named as being responsible for child abuse or neglect in Alabama. DHR releases only that information which is necessary to discover or prevent child abuse / neglect.

Substantiated report (i.e., indicated) located. See attached information.

Type Report:

Physical Abuse

Neglect

Sexual Abuse

Mental Abuse / Neglect

No report located.

 

 

 

 

Request Denied

______________________________________________________________________________

Other _________________________________________________________________________________________

_________________________________________________________

______________________________________

Office of Child Protective Services

 

 

Date Completed

DHR-FCS-1598 (Revised December 2009)

Form Specifications

Fact Name Description
Purpose of the Form The Alabama Central Registry Clearance form is used to request a background check for individuals who will provide unsupervised care for children.
Governing Law This form is governed by Alabama state law concerning child abuse and neglect reporting, specifically under the Alabama Code Title 26, Chapter 14.
Submission Instructions Instructions for submitting the form, including the appropriate address, are provided on the back of the form.
Information Release The form includes a waiver allowing the Alabama Department of Human Resources to release information from the Central Registry about the individual being cleared.

Alabama Central Registry Clearance: Usage Guidelines

After completing the Alabama Central Registry Clearance form, the next step involves submitting it to the appropriate agency. Ensure that all information is accurate and complete before sending the form to avoid delays in processing.

  1. Obtain the Alabama Central Registry Clearance form from the Alabama Department of Human Resources website or office.
  2. Print or type your information clearly in black or blue ink.
  3. In the "Requesting Person or Agency/Organization" section, check all applicable boxes, such as "Child Placing Agency" or "Residential Child Care Facility."
  4. Fill in the mailing address, telephone number, and email address of the requesting person or agency.
  5. Print the requestor’s name and specify the date.
  6. Sign the form as the requestor and include the date of signature.
  7. Provide the name and identifying information of the individual who will provide unsupervised care for children, including their sex, race, and date of birth.
  8. Complete the current mailing address and list any aliases, maiden names, or prior married names of the individual.
  9. Include the names and dates of birth of the spouse and former spouses, as well as any children or stepchildren.
  10. List the Alabama counties where the individual has lived and/or worked.
  11. Attach additional pages if necessary to provide all requested information.
  12. Have the individual being cleared sign the authorization section, waiving their right to review or hearing.
  13. Include the date of the individual’s signature and the signature of a witness, along with the date of the witness's signature.
  14. Submit the completed form to the address specified in the instructions provided on the form.

Your Questions, Answered

What is the purpose of the Alabama Central Registry Clearance form?

The Alabama Central Registry Clearance form is used to check an individual's history regarding child abuse or neglect. This form is essential for organizations or individuals providing unsupervised care for children, such as child care centers or foster care agencies. By completing this form, the requesting agency can ensure that the person in question has not been previously identified as responsible for child abuse or neglect in Alabama.

Who needs to fill out this form?

The form must be completed by any person or agency that will employ or volunteer someone who will provide unsupervised care for children. This includes child care facilities, residential child care organizations, and family day care homes. The individual being cleared must also provide their personal information and consent to the background check.

How do I submit the Alabama Central Registry Clearance form?

To submit the form, first ensure that it is filled out completely and accurately. Follow the instructions provided on the back of the form for the correct mailing address. It is crucial to send the form to the appropriate department to avoid delays in processing. Be sure to keep a copy for your records before sending it off.

What happens after I submit the form?

Once the form is submitted, the Alabama Department of Human Resources will conduct a search of the Child Abuse/Neglect Central Registry using the information provided. You will receive a response indicating whether any substantiated reports were found. If a report exists, it will detail the type of abuse or neglect. If no report is found, you will be notified that the request has been approved. Keep in mind that the process may take some time, so patience is important.

Common mistakes

  1. Inaccurate Personal Information: Failing to provide correct details such as name, date of birth, or current address can lead to delays or denials in processing the form.

  2. Omitting Required Signatures: Not signing the form or missing the witness signature can invalidate the submission, causing the application to be rejected.

  3. Incorrect Submission Address: Sending the form to the wrong address, despite instructions, may result in lost documents or extended processing times.

  4. Failure to Attach Additional Information: Not including necessary supplementary pages for detailed information can lead to incomplete applications.

  5. Using Unapproved Ink: Filling out the form in colors other than black or blue ink could render the form unacceptable.

  6. Neglecting to Specify Role: Not clearly stating the job or role of the person being cleared can cause confusion and delay in processing.

  7. Ignoring Instructions: Disregarding specific guidelines provided on the form, such as how to complete sections, can lead to errors that affect the outcome.

Documents used along the form

The Alabama Central Registry Clearance form is a crucial document used to ensure the safety of children by screening individuals who will provide unsupervised care. Along with this form, several other documents are often required or recommended to facilitate the clearance process. Below are five such documents, each serving a specific purpose in the context of child care and protection.

  • Background Check Authorization Form: This form grants permission for a comprehensive background check, including criminal history and other relevant records. It is essential for verifying the suitability of individuals working with children.
  • Employment Application: This document provides detailed information about the applicant's work history, qualifications, and references. It helps organizations assess the candidate's experience and suitability for child care roles.
  • Child Care Provider Agreement: This agreement outlines the terms and conditions under which a child care provider will operate. It includes details about responsibilities, expectations, and compliance with state regulations.
  • Health and Immunization Records: These records confirm that the individual has received necessary vaccinations and is in good health. They are vital for ensuring the well-being of children in care settings.
  • Personal References Form: This form collects contact information for individuals who can vouch for the applicant's character and suitability for working with children. References provide valuable insights into the applicant's reliability and temperament.

Each of these documents plays a significant role in the overall process of ensuring that individuals entrusted with the care of children meet the necessary standards for safety and well-being. Proper completion and submission of these forms can help prevent potential risks and foster a secure environment for children.

Similar forms

  • Child Abuse Background Check: Similar to the Alabama Central Registry Clearance form, this document is used to assess an individual’s history regarding child abuse allegations. It requires personal information and consent for the release of relevant records.
  • Foster Care Application: This application collects extensive personal details about potential foster parents. Like the Alabama form, it aims to ensure the safety and well-being of children by evaluating the applicant's background.
  • Child Care Licensing Application: Child care providers must complete this application to obtain a license. It includes background checks and personal information to verify the suitability of individuals working with children.
  • Volunteer Background Check Form: Organizations that involve volunteers with children often require this form. It serves a similar purpose by gathering consent and personal details to conduct background checks.
  • Employment Application for Child-Related Positions: This application often includes a section for background checks. It parallels the Alabama form in that it seeks to ensure the applicant has no history of child abuse or neglect.
  • Home Study for Adoption: This document is used to assess prospective adoptive parents. It requires a thorough evaluation of the applicants, similar to the scrutiny involved in the Alabama Central Registry Clearance.
  • Criminal Background Check Form: This form is utilized across various sectors to evaluate an individual's criminal history. It shares the same goal of protecting vulnerable populations, particularly children, from potential harm.

Dos and Don'ts

When filling out the Alabama Central Registry Clearance form, it is essential to approach the task with care and attention to detail. Here are seven guidelines to help ensure a smooth process:

  • Do print or type your information clearly using black or blue ink. This ensures that all details are legible and reduces the chance of errors.
  • Do check all applicable boxes for the requesting person or agency. This provides clarity on who is seeking the clearance.
  • Do provide complete and accurate information regarding your current mailing address and any aliases or prior names. Incomplete information can delay processing.
  • Do sign and date the form in the designated areas. Your signature authorizes the release of your information and is a crucial part of the process.
  • Don't leave any sections blank. If a question does not apply to you, indicate that clearly rather than omitting it.
  • Don't forget to attach additional pages if necessary. If you need more space to provide information, include those pages rather than cramming everything into the provided sections.
  • Don't submit the form without reviewing it for accuracy. A final check can help catch any mistakes that might otherwise lead to delays.

By following these guidelines, you can help ensure that your application is processed efficiently and effectively. Your attention to detail reflects your commitment to the well-being of children and the integrity of the care provided.

Misconceptions

Misconceptions about the Alabama Central Registry Clearance form can lead to confusion regarding its purpose and process. Below are eight common misconceptions, along with clarifications for each.

  • The form is only for employees in child care settings. This form is also applicable to volunteers and individuals providing unsupervised care for children, not just paid employees.
  • Submitting the form guarantees clearance. Completion and submission of the form do not guarantee that a person will be cleared. The Alabama Department of Human Resources conducts a thorough review before granting clearance.
  • Only serious offenses will show up on the registry. The registry may include any substantiated reports of child abuse or neglect, regardless of the severity of the offense.
  • Once cleared, a person remains cleared indefinitely. Clearance is not permanent. Future reports or changes in circumstances may prompt a reevaluation of a person's status.
  • There is no need to provide detailed information. The form requires comprehensive personal information, including aliases, prior names, and details about family members, to conduct an accurate search.
  • Only the person being cleared needs to sign the form. A witness signature is also required, ensuring that the process is transparent and verifiable.
  • All information is automatically confidential. While the Alabama Department of Human Resources protects personal information, certain details may still be disclosed if necessary to prevent child abuse or neglect.
  • The form can be submitted without following specific instructions. It is essential to adhere to the submission guidelines provided, including the correct mailing address, to avoid delays in processing.

Understanding these misconceptions can help individuals navigate the Alabama Central Registry Clearance process more effectively.

Key takeaways

Filling out the Alabama Central Registry Clearance form is an important step for individuals or organizations seeking to provide care for children. Here are some key takeaways to keep in mind:

  • Use black or blue ink. Always print or type your information clearly to avoid any confusion.
  • Identify your role. Specify if you are a child placing agency, residential child care facility, or another type of organization.
  • Provide complete contact information. Ensure your mailing address, telephone number, and email are accurate.
  • List all relevant names. Include aliases, maiden names, and prior married names when applicable.
  • Detail your history. Mention all Alabama counties where you have lived or worked.
  • Authorization is required. The person being cleared must authorize the release of their information.
  • Understand the implications. By signing, you waive your right to review or appeal the information released.
  • Be aware of the results. The form will indicate if there are any substantiated reports of abuse or neglect.
  • Witness signatures are necessary. Ensure that both the requestor and a witness sign and date the form.
  • Submit to the correct address. Follow the instructions provided on the back of the form for submission.

Completing this form accurately is essential for ensuring the safety and well-being of children in care. Take your time and double-check all entries before submitting.